What Is the Certification Broker Form Used For?
The certification broker form confirms that an attached Certificate of Insurance is accurate in all material respects. Insurance brokers or agents in New York City submit this form when a city agency or contracting party requires proof of valid insurance coverage. It is commonly needed for construction permits, vendor agreements, and city contracts.
How to Fill Out the Certification Broker Form
Completing this form takes only a few steps. First, enter your typewritten name and business address. Next, add your email address and phone or fax number. Then, an authorized official at the brokerage must sign the form. Finally, bring the signed form to a Notary Public for notarization. The notary will add their seal, signature, and commission expiration date.
What Documents Do You Need?
Before filling out the form, gather a copy of the Certificate of Insurance you are certifying. You will also need valid photo identification for the notarization step. If you work with related insurance documents, you may find the commercial liability insurance certificate or the ACORD 130 form helpful for your records.
Tips for Completing the Form Correctly
Double-check that the broker’s name on this form matches the name on the Certificate of Insurance exactly. Any discrepancy can cause delays or rejection by city agencies. Make sure the notarization is current and the notary’s commission has not expired. If you handle other brokerage paperwork, you can also access the broker carrier agreement form and the broker fee agreement form on FormsPal.